Revenue Cycle Claims Specialist

Azalea Health Innovations Inc • Valdosta, GA

18h

About The Position

The Revenue Cycle Claims Specialist manages the lifecycle of claims to ensure accurate, timely submission and resolution. The role reviews, validates, and resolves claim issues before and after submission, with a focus on reducing rejections, minimizing denials, and accelerating reimbursement. The specialist works with clearinghouses, payers, clients, and internal teams to correct claim errors, monitor claim status, and ensure compliance with payer requirements and billing guidelines. The position calls for strong attention to detail, analytical thinking, and a proactive approach to identifying and resolving barriers to clean claim submission and payment.

The role also supports new client or payer onboarding by helping ensure claims are correctly set up and workflows are established. It requires maintaining accurate claim activity documentation and protecting patient health information in accordance with HIPAA. Success involves initiative, a focus on outcomes, adaptability, collaboration, and innovative problem-solving.

Requirements

• Minimum 2 years of experience in progressive RCM billing and coding.
• Minimum 1 year of customer service/client relations and employee training experience.
• Excellent computer skills, including strong proficiency with web-based and SaaS applications.

Nice To Haves

• Associate or bachelor's degree preferred.
• CPC, CPB, or equivalent certification highly preferred.

Responsibilities

• Review and validate claims for accuracy, completeness, and compliance before submission.
• Ensure required claim elements are present, including coding, modifiers, and authorizations.
• Submit claims promptly through clearinghouses or payer portals.
• Meet productivity benchmarks and KPIs for claim processing and submission.
• Review claim edits and scrubbing rules to identify errors before submission.
• Correct issues involving coding, modifiers, eligibility, or missing information.
• Monitor and resolve clearinghouse edits and rejections, as well as payer rejection reports, daily.
• Research and resolve rejected claims promptly to avoid payment delays.
• Identify root causes of rejections and implement corrective actions.
• Track rejection trends and escalate systemic issues.
• Stay current on payer-specific billing requirements, edits, and submission guidelines.
• Ensure claims comply with payer guidelines, regulatory requirements, and internal SOPs.
• Maintain accurate documentation of claim activity and corrections.
• Identify recurring claim errors, rejection patterns, and workflow inefficiencies.
• Provide feedback to leadership and cross-functional teams to improve clean claim rates.
• Support onboarding of new clients or payers by ensuring proper claim setup and workflows.
• Communicate directly with clients through tasks to help resolve claim-related issues.
• Partner with internal teams to resolve claim issues.
• Maintain HIPAA compliance when handling protected health information.

Benefits

• Medical, dental, vision, and life insurance coverage options.
• Employer-sponsored subsidy toward employee medical insurance premiums.
• Azalea Health covers 100% of premiums for Life AD&D and Long-Term Disability for eligible full-time employees.
• Paid Time Off (PTO) options; employees earn and use time as they choose.
• Competitive total rewards package and advancement opportunities.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed